Saturday, January 9, 2010

Easy For You To Say

Many years ago - perhaps around 1980 - I read an article or a book about stuttering that contained a claim that stayed with me for some reason. It wasn’t particularly noteworthy to me at the time, but it buried into my memory and stayed available until now. The writer proposed a problem in the stuttering community. I don’t recall his exact words, but to paraphrase, he said that there was a problem with mild stutterers giving advice to more severe stutterers.

Here, I’ll describe the problem he saw (as I remember it), and comment and elaborate on it as I go along. He described a situation in which people with a relatively mild case of stuttering set up a local self-help group. It takes a certain amount of confidence to do so, so we shouldn’t be surprised that a person who has a relatively mild stutter would be the one to do so. Notices go up, maybe a listing in the local newspaper, and a few brave stutterers show up for the first meeting.

As the founder of the group, and already having a reasonable degree of fluency, our mild stutterer becomes the leader of the group. We can imagine that other members with a more severe condition might hang back, happy to be in the group, but still not willing to do a lot of talking.

So time goes by, they meet each month, and gradually the leader - and any other mild stutterer in the group - start to get confident in their speech in front of the group. After all, in the land of severe stutterers, they actually become the (relatively) fluent ones. The group gives them practice speaking in front of an audience, and to get long pent-up frustrations off their chest. For these mild stutterers, the group is truly therapeutic.

Time passes, the mild stutterers keep benefiting, while the more severe stutterers gain a sense of community, but little else. It’s nice to make friends and share stories with other stutterers, but they still tend to hang back and let the more fluent do much of the talking. Their speech in front of the group changes little, and any benefit goes away when they leave the meeting room.

Finally, the leader and the other mild stutterers decide that they’ve derived all the benefit they can from the group, so they decide to leave it and use their new-found confidence in their every-day lives. Which leaves the more severe stutterers to themselves. Now, with the more fluent and talkative stutterers gone, no one picks up the leadership, the group becomes less positive and affirming, and it gradually breaks up.

So those whose speech could be expected to benefit the most have harvested the benefit and moved on, and those most in need have been left behind with little to show. Unfortunately, I can’t cite the author of the above, much-paraphrased story, but that was the gist of it as I remember. If it sounds familiar to anyone, I’d love to hear from you.

I can’t vouch for the validity of the story, but it certainly made sense me, enough to remember it after all these years. It’s hard to imagine anyone making it up, so let’s go with it and assume it has some factual basis. I think it’s reasonable to say that in any self-help, self-improvement group, there’s a point where people feel like they’ve gotten all the benefit from the group they can, and they move on. In this case, we have a situation in which one group - the mild stutterers - are capable of improvement to the degree that they no longer feel the need for therapy of any kind. They were relatively (to severe stutterers) fluent already, and by simply adding experience with public speaking and a degree of confidence they become ready to face the world. The other group - the more severe and persistent stutterers - began far from fluent, and any benefits they could gain from the group meetings leave them still far from confident and far from fluent. And disappointed at being “left behind.”

This brings up back to the dynamics of the group itself. It’s natural in such a group for members to share experiences and problems and advice. If it was a writer’s group, we could imagine the sharing of methods to get past writer’s block. For stutterers, it would be natural to talk about how each member understands the nature of stuttering - nature of nurture, perhaps - and to discuss any methods they’ve used to gain more fluency.

Here, we run into the original problem posed by the author. Who is more likely to consider themselves a role model for relatively severe stutterers than another stutterer with greater fluency? Even a stutterer with little disfluency can be expected to remember severe blocks and terrible anxiety during their younger years. When severe stutterers discuss their frustration and pain, it can all be perfectly familiar to the now-mild stutterer. So why shouldn’t such a person want to help a fellow sufferer and pass on advice to them?

The question this brings up in my mind is, to what degree are the experiences of the mild, improving stutterer and the severe, persistent stutterer the same? They obviously differ quantitatively, in terms of blocks per 100 words, or repeats per word. Might the conditions also differ in quality? Is it sufficient to speak of mild and severe stutterers as simply variations along a continuum, or is the degree of difference so great that some fundamental differences are lost by thinking in terms of degree? And if we do see a fundamental difference between mild and severe stutterers, should severe stutterers be listening to mild stutterers for advice?

The problem of the mild stutterer giving advice to the severe stutterer was proposed in a general sense by the author whose article I read those many years ago. I assume he was referring to personal experience in self-help groups, but let’s take the principle and see if we can generalize it in another direction.

Since at least Van Riper, speech therapy has attracted stutterers to the field. What could be more reasonable than victims of the condition wanting to help others who share their experience? And indeed, it seems as if there are many stuttering speech therapists out there today, both senior practitioners and newly graduating students. If so, we could apply the implications of my earlier speculation and ask: could speech pathologists who stutter be relying on their own experiences and mis-applying them to the cases of stutterers whose conditions are quite different from their own?

Time to take a step back. What is the case for stutterers working as speech pathologists? One can imagine a parent asking a speech pathologist “If you stutter, how can you help my child?” ”Physician, heal thyself” comes to mind. Of course, our stuttering speech pathologist has the obvious retort: “Who knows better than a stutterer the experience and the needs of a stutterer?” Quite so! A non-stuttering speech pathologist can learn the best practice for therapy, and can be full of empathy, but he or she can never know the experience of stuttering on a subjective level. The testimony of stutterers can communicate the facts, but cannot pass on the visceral experience of stuttering.

So here is the benefit of the stuttering speech pathologist. But if we go back to the content of the previous paragraph, we can probe further and ask: if stuttering speech pathologists are using their subjective experience when seeking to understand the condition and working with clients - and it’s hard to imagine them not doing so - then if their condition actually differs in some important, qualitative way from some stutterers (less, as opposed to more severe, perhaps), then could their own subjective experience be causing them to misunderstand the condition in a particular client?

The non-stuttering therapist lacks the subjective knowledge of stuttering. They may simply not get it. Then again, they also lack the stutterer’s confidence that they understand the phenomenon on a personal level. Thus, they can’t suffer from incorrectly generalizing their own subjective experience to their clients. In the best case, a non-stuttering therapist would come to the condition with an open mind, and remain open to new evidence and analysis.

So let’s go back to the beginning, and ask some questions. Does it make sense that mild and severe stuttering could be qualitatively different in such a way that stutterers from opposite ends of the continuous spectrum are significantly different in some way(s)? It is possible that those hypothetical differences could cause stutterers to mistakenly generalize their own experiences to others? And if so, could the advice - or even simply self-reporting - given by mild stutterers, in either self-help groups or in clinical practice, be doing a dis-service to more severe stutterers?

I dunno - I’m just asking.

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